医学疾病相关的紧张症：病因学、现象学和治疗方面的差异和相似之处。

Catatonia in the medically ill: Differences and parallels in etiology, phenomenology and management.

机构信息

Department of Psychiatry, Rush University Medical Center, Chicago, IL, USA.

Department of Psychiatry, University of Chicago, Chicago, IL, USA.

出版信息

Int J Psychiatry Med. 2022 Jan;57(1):80-88. doi: 10.1177/0091217421994078. Epub 2021 Feb 10.

DOI:10.1177/0091217421994078

PMID:33567935

Abstract

OBJECTIVE

Catatonia is a disorder characterized by psychomotor symptoms. The etiology, symptomatology, response and outcome of catatonia in the medically ill has not been vigorously studied. Those who have catatonia associated with another mental disorder versus. catatonic disorder due to another medical condition may differ. The aim of this study is to study the causes, phenomenology and outcomes of medically ill patients with catatonia and explore differences among those who have catatonia associated with psychiatric illness vs. systemic medical illness.

METHOD

We studied the incidence of catatonic symptoms in medically hospitalized patients to identify any apparent differences in clinical manifestations due to distinctive etiologies. Specifically, we assessed if there are differences between those who had catatonia associated with another mental disorder versus those with catatonic disorder due to another medical condition in their phenomenology, management and likelihood of response to treatment.

RESULTS

Of our 40 patients, 18 patients (45%) had catatonia associated with another mental disorder, 17 (42.5%) had catatonic disorder due to another medical condition, and in 5 patients (12.5%) the cause of catatonia was not identified. The most common catatonic symptoms regardless of etiology in our medically ill were mutism, followed by rigidity, and immobility. Bipolar disorder, schizophrenia, major depressive disorder, metabolic abnormalities, anti NMDAR encephalitis were the most frequent causes of catatonia in our medically ill patients. Compared to subjects with catatonic disorder due to another medical condition, those with catatonia associated with another mental disorder had more frequent mannerisms (Chi-square = 4.27; p = 0.039), waxy flexibility (Chi-square = 11.0; p < 0.01), and impulsivity (Chi-square = 4.12, p = 0.042). Nonsignificant trends were noted for posturing (Chi-square = 3.74, p = 0.053), perseveration (Chi-square = 3.37, p = 0.067), and stereotypy (Chi-square = 2.91, p = 0.088) also being more frequent in catatonia associated with a psychiatric cause.

DISCUSSION

Our data supports phenomenological differences between medical and psychiatric causes of catatonia in the medically ill.

摘要

目的

紧张症是一种以精神运动症状为特征的障碍。患有内科疾病的紧张症的病因、症状、反应和结果尚未得到深入研究。那些伴有其他精神障碍的紧张症患者与因其他躯体疾病引起的紧张症患者可能存在差异。本研究旨在研究患有内科疾病的紧张症患者的病因、表现和结果，并探讨伴有精神疾病与系统性躯体疾病的紧张症患者之间的差异。

方法

我们研究了内科住院患者出现紧张症症状的发生率，以确定由于不同病因导致的临床表现是否存在明显差异。具体来说，我们评估了伴有其他精神障碍的紧张症患者与因其他躯体疾病引起的紧张症患者在表现、治疗管理和治疗反应可能性方面是否存在差异。

结果

在我们的 40 名患者中，18 名（45%）患者的紧张症与其他精神障碍有关，17 名（42.5%）患者因其他躯体疾病而出现紧张症，5 名（12.5%）患者的紧张症病因未明。无论病因如何，我们内科疾病患者中最常见的紧张症症状是缄默症，其次是僵硬和不动。双相情感障碍、精神分裂症、重度抑郁障碍、代谢异常、抗 NMDAR 脑炎是我们内科疾病患者紧张症的最常见病因。与因其他躯体疾病引起的紧张症患者相比，伴有其他精神障碍的紧张症患者更常出现刻板动作（卡方检验=4.27，p=0.039）、蜡样灵活性（卡方检验=11.0，p<0.01）和冲动性（卡方检验=4.12，p=0.042）。姿势（卡方检验=3.74，p=0.053）、持续状态（卡方检验=3.37，p=0.067）和刻板动作（卡方检验=2.91，p=0.088）也有出现更频繁的趋势，但差异无统计学意义。